(1) Process requests for Prior Authorizations within 24 hours. Re-cert from 4 days to 1 month after initial authorization depending on MCO and program.
(2) Review structured clinical data and diagnoses and follow established procedures for request for authorization.
(a) Review/ensure ASAM is updated weekly at appropriate program location.
(b) Ensure all service documentation is entered within 24 hours to ensure all necessary documentation for reviews.
(c) Review/ensure treatment plan are completed, updated, and signed appropriately according to specific
program.
(3) Verify eligibility within the database systems to members and providers. Enter authorizations in an auth screen and set appropriate priority on insurance layers. Set calendar for review date.
(4) Determine coverage and approval utilizing EHR for pre-auth and reviews.
(5) Review ASAM criteria annually to ensure Center is up-to-date with any changes.
(6) Review regulations to ensure that all state and federal rules and regulations are followed as they apply to the position.
(7) Review the Medical Necessity guidelines regularly to ensure accuracy.
(8) Other duties as required/assigned.

SKILLS:

Must have great problem-solving skills, strong typing skills, excellent written and oral communication skills, strong service orientation, flexible and adaptable to quick changing environment(s), and have the ability to work as a team player.

MINIMUM QUALIFICATIONS:

Minimum high school graduate. Computer literacy including information management, network organization and word-processing. Minimum 2 years experience in behavioral health setting preferred. Minimum 2 years experience using an electronic health record preferred.

About Pennyroyal Center

We are proud to be a CARF accredited agency for our Outpatient Services and Therapeutic Foster Care Programs. The Pennyroyal 24 hour RESPOND Center is also now a proud partner of the National Suicide Prevention Lifeline. Our clinical assessors are available anytime day or night. You can also text us at 839863 keyword RESPOND.